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From: [email protected]
Subject: Depression
Some of the MD's in this newsgroup have been riding my butt pretty good
(maybe in some cases with good reason). In this post on depression, I'm
laying it all out. I'll continue to post here because I think that I have
some knowledge that could be useful. Once you have read this post, you
should know where I'm coming from when I post again in the future.
In article <[email protected]>, [email protected] (Lida Chaplynsky) writes:
>
> A family member of mine is suffering from a severe depression brought on
> by menopause as well as a mental break down. She is being treated with
> Halydol with some success but the treatments being provided through her
> psychiatrist are not satisfactory. Someone suggested contacting a
> nutritionist to
> discuss alternative treatment. Since she is sensitive to medication, I
> think this is a good suggestion but don't know where to begin. If anyone
> can suggest a Philly area nutritionist, or else some literature to read,
> I'd appreciate it.
Lida,
I can emphasize with your situation. Both my wife and I suffered from
bouts of depression. Her's was brought on by breast cancer and mine was a
rebound stress reaction to her modified radical mastectomy and
chemotherapy. Lida, I used my knowledge of nutrition to get her through
her six months of chemotherapy(with the approval of her oncologist). When
severe depression set in a few months after the chemo stopped, I tried to
use supplements to bring her out of it. I had "cured" her PMS using
supplements and I really thought that I knew enough about the role of diet
in depression to take care of her depression as well. It didn't work and
she was put on Prozac by her oncologist. Two Winters ago(three years after
by wife's breast cancer) I got hit with severe depression(pretty typical and
one reason why many marriages break up after breast cancer or another
stressor). I tried to take care of it for several months with
supplementation. Didn't work. My internist ended up putting me on Prozac.
I was going to give you a list of several studies that have been done using
B6, niacin, folate and B12 to "cure" depression. I'm not going to do that
because all you would be doing is flying blind like I was.
Lida, I do believe that depression can have a dietary component. But the
problem is that you need to know exactly what the problem is and then use
an approach which will "fix" the problem. For chemotherapy, I knew exactly
what drugs were going to be used and exactly what nutrients would be
affected. Same thing for PMS. I was flying blind for both of these
stressors but the literature that I used to devise a treatment program was
pretty good. Depression is just too complicated. What you really need is
a nutritional scan. This is not a diet analysis but an analysis of your
bodies nutrient reserves. For every vitamin and mineral(except vitamin C),
you have a reserve. The RDA is not designed to give you enough of any
nutrient to keep these reserves full, it is only designed to keep them from
being emptied which would cause clinical pathology. Stress will increase
your need for many vitamins and minerals. This is when your reserves become
very important.
Lida, without your permission, I'm going to use your post as a conduit to
try to explain to the readers in this group and Sci. Med. where I'm coming
from. I have taught a course on human nutrition in one of the Osteopathic
Medical schools for ten years now. I've written my own textbook because
none was available. What I teach is not a rehash of biochemistry. I
preach nutrient reserves(yes my lectures in this course are referred to by
my students as sermons). Here is what I cover:
Indroduction and Carbohydrates Lipids
Proteins I Proteins II
Energy Balance Evaluation of Nutritional
Status I, A Clinical
Perspective
Evaluation of Nutritional Status II, Evaluation of Nutritional
A Biochemical Perspective Status III, Homework
Assignment Using the
Nutritionist IV Diet and
Fitness Analysis Software
program
Weight Control Food Fads and Facts
Age-Related Change in Nutrient Requirements Food Additives,
Contaminants and Cancer
Drug-Nutrient Interactions Mineral and Water Balance
Sodium, Potassium and Chloride Calcium, Magnesium and
Phosphorus
Iron Zinc and Copper
Iodine and Fluoride Other Trace Minerals
Vitamin A Vitamin E
Vitamins D and K Vitamin C
Thiamin and Niacin Riboflavin and Pyridoxine
Pantothenic and Folic acids Biotin and B12
Other Nutrient Factors Enteral Nutrition
Parenteral Nutrition
Every three years I spend my entire Summer reviewing the Medical literature
to find material that I can use in my nutrition textbook. I last did this
in the Summer of 1991. I read everything that I can find and then sit down
and rewrite my lecture handouts which are bound in three separate books
that have 217, 237 and 122 pages. Opposite each page of written text(which
I write myself) I've pulled figures, tables and graphs from various
copyrighted sources. Since this material is only being used for
educational purposes, I can get around the copyright laws (so far). I can not
send this material out to newsgroup readers(as I've been asked to do).
I am now in the process of trying to get a grant to setup a nutrition
assessment lab. This is the last peice of the nutrition puzzle that I need
to make my education program complete. This lab will let me measure the
nutrient reserve for almost all the vitamins and minerals that are known to
be required in humans. The Mayo clinic already uses a similiar lab to
design supplement programs for their cancer patients. Cancer Treatment
Centers of America, which is a private for-profit organization with
hospitals in Illinois and Oklahoma(Tulsa) also operates a
nutritional assessment clinical lab. I also believe that the Pritikin
Clinic in California has a similiar lab setup.
For physicians reading this post, I would suggest that you get the new
Clinical Nutrition Textbook that has just been published(Feb) by Mosby. I
have been using Alpers Manual of Nutritional Therapeutics(a Little Brown
series book) as a supplemental text for my course but Alpers is geared more
to residency training. Two M.D's have written this new Clinical Nutrition
textbook and it is geared more towards medical student education and it
does a good job of covering the lab tests that can be run to assess a
patient's nutritional status. Let me quote a few sentences from the
Preface of this new text:
"So-called nutrition specialists were in reality gastroenterologists,
hematologists, or pediatricians who just happened to profess some knowledge
of nutrition as it related to their field of practice."
"Unfortunately, about two thirds of the medical schools in the United
States require no formal instruction in nutrition."
"But times and medical practice have changed. More than half of the
leading causes of death in this country are nutrition related."
"... this monograph should accomplish the following two objectives: (1) it
should complement your medical training by emphasizing the relevance of
nutrition to your medical practice; and (2) it should heighten your
awareness of nutrition as a medical speciality that is vitally important
for both disease prevention and the treatment of diseases of essentially
every organ system."
Roland L. Weinsier, MD, DrPH
Lida, my advise to you is that you tell your family members to try to find
a physician who has an understanding of the role that vitamins and minerals
(yes even magnesium may play a role in depression) play in depression and
who could get a nutritional profile run. Menopause is often a time when
women suffer depression. There are a lot of hormonal changes that are
occuring but they are not the same ones that occur during PMS. A
nutritionist may also be able to help. Not too long ago a poster mentioned
that his nutritionist had diagnosed a selenium deficiency based on a red
cell glutathionine peroxidase test(the specific test for the selenium
reserve). Most clinical labs will not run this test and I advised him to
try to make sure that the lab that did the test was certified. There are
also a lot of hair and nail analysis labs setup to do trace mineral
analysis but these labs are not regulated. Checks of these labs using
certified standards, and also those doing water lead analysis, showed some
pretty shoddy testing was going on. If you or anyone else finds someone
who will run these speciality nutrition tests, make sure that they are
using a lab that has been certified under CLIA(the Clinical Laboratory
Improvement Act).
A diet analysis may be helpful since many nutrient reserves have been shown
to correlate fairly well with the dietary intake as monitored by food logging
and software analysis(Nutritionist IV and other software programs). But
there are still about half of the nutrients required by humans that do not
show a very good correlation between apparent dietary intake and reserve status.
Until we have more nutritional assessment clinical labs in operation in the
U.S. and physicians who have been trained how to use the nutritional
profile that these labs provide to devise a treatment approach that uses
diet changes and supplementation, anti-depressants will probably continue
to be the best approach to depression.
Martin Banschbach, Ph.D.
Professor of Biochemistry and Chairman
Department of Biochemistry and Microbiology
OSU College of Osteopathic Medicine
"Without discourse, there is no remembering, without remembering, there is
no learning, without learning, there is only ignorance."
